Stress Fractures in Athletes: From Pathophysiological Mechanisms to Evidence-Based Diagnostic and Therapeutic Strategies

Background: Stress fractures (SFs) occur due to repetitive submaximal loading exceeding the bone’s intrinsic repair capacity. SFs constitute a significant challenge among endurance athletes and substantially compromise athletic performance and disrupt training continuity, requiring a comprehensive and multidisciplinary therapeutic approach. Objective: This review synthesises current evidence on the etiology, pathophysiology, diagnosis, and management of SFs in athletes. Methods: A literature review was conducted to evaluate diagnostic standards and therapeutic strategies for bone stress injuries. Results: SFs develop along a pathological continuum. Risk factors include abrupt training load transitions and metabolic disturbances like the Female Athlete Triad. While X-rays lack early sensitivity, MRI is the gold standard for diagnosis. Management is risk-stratified: low-risk fractures are typically managed conservatively, whereas high-risk fractures often require surgery or prolonged immobilisation. Conclusion: Systematic workload management and early, risk-based intervention are essential for effective recovery and the prevention of training interruptions.